FILLING OUT THE NPWT INITIAL ORDER FORM:
Complete all three pages
Make sure the patient name and ALL lines are completed in the prescribers box on page 3.
Print and have the physician sign and date, fax back to us at 888-665-4199.
Once completed orders and clinical information are received by us, we will submit for authorization (if required).
If you are treating more than one wound complete a Secondary Wound Order Form also.
Download to your hard drive and fill out form electronically.
Once physician has signed and dated completed orders, fax to 888-665-4199